Perioperative Leukocyte Changes And Short-term Prognosis In Diabetic Lumbar Fusion

Objective:To investigate the changes of white blood cells(WBC)and their subsets,platelet to lymphocyte ratio(PLR)and neutrophils to lymphocyte ratio(NLR)in patients with type2 diabetes mellitus during perioperative period of posterior lumbar interbody fusion(PLIF)under general anesthesia,and their relationship with short-term prognosis.Methods:A retrospective analysis was made of 216 patients aged 40 to 82 who underwent PLIF in the spinal surgery department of the Second Hospital of Shanxi Medical University from January 2016 to May 2018.Among them,81 were in the diabetes group(DM group)and 135 were in the non-diabetes group(NDM group).Age,sex,body mass index(BMI),American Society of Anesthesiologists(ASA)grade,hypertension or not,the total number and classification of white blood cells in blood routine before and 1 day after operation were collected,and NLR and PLR were calculated,glycosylated hemoglobin.Postoperative drainage volume,indwelling time of drainage tube,and hospitalization time after operation were also calculated.Results:Compared with preoperative,two groups of postoperative white blood cells(WBC),neutrophil(N)and mononuclear cells(M)counts were increased,lymphocyte counts(L)reduced(P < 0.01),postoperative neutrophils to lymphocytes ratio(NLR)and platelet to lymphocyte ratio(PLR)also increased(P < 0.01);Compared with NDM group,theincreased range in the DM group were smaller than the NDM group between postoperative and preoperative counts of WBC and N respectively(P<0.01).The postoperative NLR was also lower in the DM group than that in the NDM group(P<0.01),and the postoperative drainage indwelling time,postoperative drainage flow,postoperative hospitalization time were relatively longer(P<0.05).Preoperative NLR is a predictor of postoperative drainage volume(P<0.01),there was no significant correlation between glycosylated hemoglobin and NLR,PLR(P > 0.05).Conclusion:Perioperative leukocyte stress response decreases in diabetic patients.Short-term prognosis is poor.Preoperative NLR is associated with short-term prognosis,while PLR is not correlated with short-term prognosis.